Outstanding Alumni Awards

MSU Billings Outstanding Alumni Nomination Form

The Montana State University Billings Alumni Association's
Outstanding Alumni Awards Program recognizes
MSU Billings Alumni who have made
exceptional contributions to society, their professions, and the University.

This form is for your convenience, as you supply information about your nominee,
and will be submitted to
the Alumni Awards Selection Committee for their review.

No member of the Outstanding Alumni
Awards Selection Committee
may make a nomination.
Self nominations are accepted.

Please provide
Nominee's information:

First Name

Last Name

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

Home Phone

FAX

E-mail

Please provide Nominator's information:

First Name

Last Name

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

Home Phone

FAX

E-mail

Please list three
references (individual or business), including name, address and telephone, who
could provide additional information on your nominee.